Worst Claim Story- July 2018

By Belle DuCharme, CDPMA, Dental Training Consultant

Unpaid Implant Supported Crown

“The claim has been paid and the check was sent to the provider on (date)”, replied the insurance agent in a terse tone.  This particular agent was not going to give up any information that she didn’t want to give, obviously having a bad day.  “We have not received the payment, can you tell me who cashed the check?” I asked to which she replied,  “NO!!, I cannot tell you that, you will have to file an appeal and fill out the form and there will be a fee involved.”  After hanging up, I decided to do some more research.  I had already sent an inquiry to the claim because we hadn’t received payment. The patient called me once a week about the “lost” payment.  The claim was for an implant supported crown and the services had been pre-determined at the request of the patient. I decided to call the Periodontist office who had placed the implant on this patient.  Finding out that the patient’s insurance had paid them more than what they actually did, I asked the insurance coordinator to look on the EOB. The insurance had paid the periodontist for the implant crown instead of my office and that is why the credit balance.  We informed the insurance company who recalculated the claims and paid accordingly. It took about six months to straighten out.

eAssist Helpful News and Billing Tips; Edition #125


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